垂直切口内上蒂法在乳房肥大整形术中的临床应用

The clinical application of vertical incision internal and upper pedicle in mastectomy for hypertrophy

目的探讨垂直切口内上蒂法在乳房肥大整形术中的临床应用。方法自2020年3月至2023年3月,合肥市第二人民医院整形修复外科对45例乳房肥大患者采用垂直切口内上蒂法行乳房缩小上提矫正,个性化设计新乳头位置、新乳晕直径、内上真皮腺体蒂宽度等。内上蒂去表皮,切除“C”形区皮肤及皮下组织,保留2.0 cm安全皮肤罩厚度下个性化切除外侧及外上方皮肤罩深层组织,蒂部适当修整有利于旋转及塑形,修薄新旧下皱襞区,采用美容缝合技术,重新塑造乳房形态。结果共45例患者(90侧乳房)乳房上提高度为3.0~15.5 cm,切除的腺体质量380~2300 g,术后5例出现脂肪液化及切口愈合不良,经换药后愈合,乳头、乳晕血运功能良好,术后随访3~12个月,躯体不适症状明显改善,乳头感觉良好。患者对术后乳房大小、形态、瘢痕情况均较满意。结论采用垂直切口内上蒂法矫正肥大下垂的乳房,蒂部血供安全,行个性化操作,充分切除冗余组织,术后瘢痕隐蔽,乳房外形饱满对称,对部分轻度、所有中度及大部分重度乳房肥大伴下垂患者,可达到满意效果。

Objective To investigate the clinical application of vertical incision internal pedicle in mastectomy for hypertrophy.Methods From March 2020 to March 2023,45 cases of breast hypertrophy were corrected by vertical incision,and the new nipple position,the new areola diameter and the width of the inner and upper dermal gland pedicle were individually designed.The inner and upper pedicle were de-epidermis,the skin and subcutaneous tissue in the"C"shaped area were excised,and the deep tissue of the outer and upper skin coverings were personalized with the safe skin mask thickness of 2.0 cm retained.Proper pedicle trimming was conducive to rotation and shaping,the old and new lower fold areas were thinned,and the cosmetic suture technique was applied to reshape the breast shape.Results A total of 45 cases(90 breasts),the degree of elevation was 3.0 to 15.5 cm,the weight of the removed unilateral glands was 380 to 2300 g,5 cases suffered from fat liquefaction and poor incision healing after surgery,healing after dressing change,good blood flow to the nipple and areola,3 to 12 months after the operation,physical discomfort symptoms improved significantly,nipple feeling good.Patients were satisfied with breast size,shape and scar status after surgery.Conclusion The application of vertical incision in the upper pedicle method to correct hypertrophy and ptosis of the breast,with safe blood supply to the pedicle,personalized operation,full removal of redundant tissue,hidden postoperative scar,full and symmetrical breast appearance,can achieve desired satisfactory results for some mild,all moderate and most severe patients with breast hypertrophy and ptosis.